Vaginal cancer

The vagina is the muscular passageway that connects a woman’s uterus (womb) to the outside of her body and her external genitalia (vulva). Vaginal cancer is rare.

About one in every 200 Australian women with cancer have cancer of the vagina. Each year about 90 new cases of vaginal cancer are found in Australian women.

Most women with early cancer of the vagina can be cured. If the cancer is advanced, treatment can be given that will help reduce the symptoms although it is less likely that the cancer can be cured.

Vaginal cancer is often a ‘secondary cancer’, meaning the cancer started somewhere else in the body and then moved into the vagina. Cancer that starts in the vagina can easily move into other parts of the body, such as the bladder and the rectum (bottom passageway).

Causes

It is not usually possible to say what causes cancer in a particular woman but known risk factors are:

• you are over 50 years old
• you have had another gynaecological cancer in the past (such as cervical or vulvar cancer)
• you have had abnormal cells on your cervix, vagina or vulva (known as dysplasia)
• you have had the human papillomavirus (HPV)
• you have been a regular smoker
• your mother was given the synthetic hormone diethylstilbestrol (DES),  when she was pregnant with you (it was used in the 1950s to prevent miscarriage)
• cells that belong in the lining of your cervix have been found on the walls of your vagina (known as vaginal adenosis).

Some research also suggests that there may be a link between vaginal cancer and women with a prolapsed uterus who do not regularly have their pessary checked or changed.

Symptoms

Sometimes there are no signs when the cancer begins to grow because it is often very small.

Symptoms can include:

• an unusual lump inside your vagina
• bleeding from your vagina which is painless and not linked to your period
• pain during sex or bleeding from your vagina after sex
• smelly fluid or discharge coming from your vagina
• pain when you go to the toilet
• constant pain in your pelvis.

See your doctor if any of these symptoms persist and/or they are unusual for you.

Diagnosis

If you have symptoms that might be linked to vaginal cancer you should talk to a doctor, nurse or gynaecologist. You should tell them about any changes to your body that you have noticed. You should also tell them if you have ever had any cancers, HPV or other sexually transmitted diseases.

If you have symptoms that might be linked to vaginal cancer your doctor will most likely:

• ask you questions about the history of the health of you and your family
• examine your body
• do a blood test
• look at your vagina using a magnifying machine called a colposcopy that sits close to your body
• give you an injection of medicine (local anaesthetic) to numb your vagina or put you to sleep (general anaesthetic) so they can take a sample of any sores or lumps you have and send it away to be tested
• you may also have a chest x-ray, CT or MRI scan.

Treatment

The type of treatment you have will depend upon:

• the size of the cancer and where it is in your body (this is known as the stage of cancer)
• how quickly it is growing and how different it looks to normal cells (the grade of cancer)
• where in the vagina it started (the type of cancer)
• your age, health and medical history.

Your doctors will discuss these things with you and help choose the best possible treatment for your particular cancer, lifestyle and wishes.

Treatment options

• Surgery to remove the cancer. Your surgeon will remove some of the healthy tissue that surrounds the cancer to stop it from coming back. This may mean removing part or all of your vagina. Your surgeon may be able to make a replacement vagina for you using muscles and skin from another part of your body, such as your thigh. This would mean you could still have penetrative sex.
  
  Your uterus and cervix may also be removed (known as a total hysterectomy) as well as your ovaries and fallopian tubes (known as a oophorectomy) and the lymph nodes at the top of your vagina (lymphadenectomy). If the cancer has spread to other parts of your body, you may also have surgery to remove these other cancers.
• Radiotherapy to control or kill the cancer. If you have external radiation you will lie or sit near a machine that directs radiation beams at your cancer. If you have internal radiotherapy (known as brachytherapy), a small radioactive device will be put inside your vagina.
  
  If you hope to become pregnant your doctor may recommend you try radiotherapy first because it may mean you can avoid surgery to remove your vagina.
• Chemotherapy drugs to control or kill the cancer. Usually this involves being connected to an IV or drip for a few hours so the drugs can be released slowly into your body.

Questions to ask

• How big is my cancer and where exactly is it?
• Is my daughter more likely to have vaginal cancer if I have it?
• What if I want to become pregnant?
• Is there a risk that any children I have after being treated will get cancer?
• Will I still be able to have sex?
• How do I care for my vagina after the treatment?
• What are the side effects of the treatment you are recommending?
• Why is the treatment you are recommending best for me?
• How often will I need to have checkups?
• Will treatment stop my periods and start menopause?
• Can you write down what you have told me so that I can read it again later?

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